(1) There is a need in the state to transform the health care
services delivery model toward primary prevention and more
proactive care management through the development of
patient-centered medical homes;

(2) The concept of a patient-centered medical home would
promote a partnership between the individual patient, the patient's
various health care providers, the patient's family and, if
necessary, the community. It integrates the patient as an active
participant in their own health and well-being;

(3) The patient-centered medical home provides care through a
multidisciplinary health team consisting of physicians, nurse
practitioners, nurses, physicians assistants, behavioral health
providers, pharmacists, social workers, physical therapists, dental
and eye care providers and dieticians to meet the health care needs
of a patient in all aspects of preventative, acute, chronic and
end-of-life care using evidence-based medicine and technology;

(4) In a patient-centered medical home each patient has an
ongoing relationship with a personal physician. The physician
would lead a team of health care providers who take responsibility
for the care of the patient or for arranging care with other
qualified professionals;

(6) Currently there are medical home pilot projects underway
at the Bureau for Medical Services and the Public Employees
Insurance Agency that should be reviewed and evaluated for
efficiency and a means to expand these to greater segments of the
state's population, most importantly the uninsured.

(b) The patient-centered medical home is a health care setting
that facilitates partnerships between individual patients and their
personal physicians and, when appropriate, the patients' families
and communities. A patient-centered medical home integrates
patients as active participants in their own health and well-being.
Patients are cared for by a physician or physician practice that
leads a multidisciplinary health team, which may include, but is
not limited to, nurse practitioners, nurses, physician's
assistants, behavioral health providers, pharmacists, social
workers, physical therapists, dental and eye care providers and
dieticians to meet the needs of the patient in all aspects of
preventive, acute, chronic care and end-of-life care using
evidence-based medicine and technology. At the point in time that
the Center for Medicare and Medicaid Services includes the nurse
practitioner as a leader of the multidisciplinary health team, this
state will automatically implement this change.

(c) The Governor's Office of Health Enhancement and Lifestyle Planning shall consult with the Bureau for Medical Services and the
Public Employees Insurance Agency on current medical home pilot
projects which they are operating for their membership population.
The director shall evaluate these programs in consultation with the
Commissioner of the Bureau for Medical Services and the Director of
the Public Employees Insurance Agency for a means to expand these
beyond the populations currently being served by these pilots.
Once data is available on these pilots that can be reviewed for
planning purposes, the director shall utilize this as a means to
develop and implement additional patient-centered medical home
pilot programs beyond the limited populations served by the Bureau
for Medical Services and the Public Employees Insurance Agency.
The director shall develop four varying types of patient-centered
medical home pilots based upon experience gained from the projects
currently in operation at the Bureau for Medical Services and the
Public Employees Insurance Agency. These patient-centered medical
homes shall be based upon the individual practices of physicians.

(d) The four types of pilot programs shall be:

(1) Chronic Care Model Pilots. -- This model shall focus on
smaller physician practices. Primary care providers shall work
with payers and providers to identify various disease states.
Through the collaborative effort of the primary care provider and
the payers and providers, programs shall be developed to improve
management of agreed upon conditions of the patient. Through this
model, the primary care provider may utilize current practices of multipayer workgroups. These groups shall be comprised of the
medical directors of the major health care payers and the state
payers along with medical providers and others.

(2) Individual Medical Homes Pilots. -- These pilots shall
focus on larger physician practices. They shall seek certification
from the National Committee on Quality Assurance. That initial
certification will be Level I certification. This would be granted
by virtue of certifying the provider is in the process of attaining
certification and currently have met provisional standards as set
by the National Committee on Quality Assurance. This provisional
certification lasts only one year with no renewal.

(3) Community-Centered Medical Home Pilots. -- This approach
shall link primary care practices with community health teams which
would grow out of the current structure in place for federally
qualified health centers. The community health teams shall include
social and mental health workers, nurse practitioners, care
coordinators and community health workers. These personnel largely
exist in community hospitals, home health agencies and other
settings. These pilots shall identify these resources as a
separate team to collaborate with the primary care practices. The
teams would focus on primary prevention such as smoking cessation
programs and wellness interventions as well as working with the
primary care practices to manage patients with multiple chronic
conditions. Within this pilot all health care agencies are
connected and share resources. Citizens can enter the system of care from any point and receive the most appropriate level of care
or be directed to the most appropriate care. Any financial
incentives in this model would involve all health care payers and
could be used to encourage collaboration between primary care
practices and the community health teams.

(4) Medical Homes for the Uninsured Pilots. -- These pilots
shall focus on medical homes to serve the uninsured. They shall
include various means of providing care to the uninsured with
primary and preventative care. Through this mechanism, a variety
of pilots may be developed that shall include screening, treatment
of chronic disease and other aspects of primary care and prevention
services. The pilots will be chosen based on their design meeting
the requirements of this subsection and the resources available to
provide these services.

(e) The Governor's Office of Health Enhancement and Lifestyle
Planning may promulgate emergency rules pursuant to the provisions
of section fifteen, article three, chapter twenty-nine-a of this
code if they deem them necessary to implement this section.

(1) The Governor's Office of Health Enhancement and Lifestyle
Planning shall establish by guidelines, criteria to evaluate the
pilot program and may require participating providers to submit
such data and other information related to the pilot program as may
be required by the Governor's Office of Health Enhancement and
Lifestyle Planning. For purposes of this article, this information
shall be exempt from disclosure under the Freedom of Information Act in article one, chapter twenty-nine-b of this code.

(2) No later than December 1, 2009, and annually thereafter
during the operation of the pilot program, the Governor's Office of
Health Enhancement and Lifestyle Planning must submit a report to
the Legislative Oversight Commission on Health and Human Resources
Accountability as established in article twenty-nine-e of this
chapter on progress made by the pilot project including suggested
legislation, necessary changes to the pilot program and suggested
expansion of the pilot program.

Note: WV Code updated with legislation passed through the 2014 1st Special Session
The WV Code Online is an unofficial copy of the annotated WV Code, provided as a convenience. It has NOT been edited for publication, and is not in any way official or authoritative.